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Teaching  from  the  Chair  and  at  the  Bedside. 


AN 


INTRODUCTORY  LECTURE 


DELIVEKED  BEFORE  THE 


MEDICAL   CLASS  OF  HARVARD  UNIVERSITY,    / 


Noveniher  6,  1869 , 


By  OLIVER  WENDELL |HOLMES, 

PABKMAN  PROFESSOR  OP  ANATOMY  AND   PHYSIOWGY. 


PtinteU  at  tfje  requtst  of  tfje  Class, 


BOSTON: 

DAVID  CLAPP  &  SON— 334  WASHINGTON  STREET. 

1867. 


Medical  Department,  Harvard  Uniteksitt, 
November  10th,  1867. 

0.  W.  HOLMES,  M.D., 

Parkman  Professor  of  Anatomy  and  Physiology, 
Harvard  University. 

Dear  Sib  : 

The  Medical  Class  have  the  honor  of  requesting  for  publication,  a  manuscript  copy  of 
the  Introductory  Address  delivered  by  you  at  the  Opening  Exercises,  November  6th,  1867. 

Very  respectfully,  your  ob't  serv'ts, 

E.  N.  WHITTIEE, 
C.  P.  PUTNAM, 
B.  B.  KENT,  Jr., 

Committee  for  the  Class. 


164  Charles  Street,  Nov.  Xllh,  1867. 
Qestlesies  : 

I  have  much  pleasure  in  placing  the  manuscript  of  my  Introductory  Lecture  in  your 
hands  for  publication,  in  accordance  with  the  request  of  the  Medical  Class. 

Very  truly  your  friend, 

0.  W.  HOLMES. 
Messrs.  E.  N.  Whittier, 
C.  P.  Pptnam, 
B.  B.  Kent,  Jr., 

Committee 


W 


INTRODUCTORY  LECTURE. 


The  idea  is  entertained  by  some  of  our  most  sincere 
professional  brethren,  that  to  lengthen  and  multiply 
our  Winter  Lectiu'es  will  be  of  necessity  to  advance 
the  cause  of  medical  education.  It  is  a  fair  subject 
for  consideration  whether  they  do  not  overrate  the 
relative  importance  of  that  particular  mode  of  mstruc- 
tion  which  forms  the  larger  part  of  these  courses. 

As  this  School  coidd  only  lengthen  its  lecture 
term  at  the  expense  of  its  "  Summer  Session,"  m 
which  more  direct,  personal  and  familiar  teaching 
takes  the  place  of  our  academic  discourses,  and  m 
Avhich  more  time  can  be  given  to  hospitals,  infirma- 
ries, and  practical  instruction  in  various  important 
specialties,  whatever  might  be  gained,  a  good  deal 
would  certainly  be  lost  ui  our  case  by  the  exchange. 

The  most  essential  part  of  a  student's  instruction 
is  obtained,  as  I  beheve,  not  in  the  lecture-room,  but 
at  the  bedside.  Nothing  seen  there  is  lost ;  the 
rhythms  of  disease  are  learned  by  frequent  repeti- 
tion ;  its  unforeseen  occurrences  stamp  themselves 
indelibly  in   the   memory.      Before  the  student   is 


4  INTEODUCTORY   LECTURE. 

aware  of  what  he  has  acquired,  he  has  learned  the 
aspects  and  course  and  probable  issue  of  the  diseases 
he  has  seen  with  his  teacher,  and  the  proper  mode 
of  dealing  with  them,  so  far  as  his  master  knows  it. 
On  the  other  hand,  our  ex  cathedra  prelections  have 
a  strong  tendency  to  run  mto  details  which,  however 
interestmg  they  may  be  to  oiu'selves  and  a  few  of 
our  more  curious  listeners,  have  nothing  in  them 
which  will  ever  be  of  use  to  the  student  as  a  practi- 
tioner. It  is  a  perfectly  fau*  question  whether  I  and 
some  other  American  Professors  do  not  teach  quite 
enough  that  is  useless  already.  Is  it  not  well  to 
remind  the  student  from  time  to  time  that  a  physi- 
cian's bushiess  is  to  avert  disease,  to  heal  the  sick, 
to  prolong  hfe  and  to  diminish  suffering  ?  Is  it  not 
true  that  the  yomig  man  of  average  ability  Aiill  find 
it  as  much  as  he  can  do  to  fit  himself  for  these  simple 
duties  ■?  Is  it  not  best  to  begin,  at  any  rate,  by 
making  sure  of  such  knowledge  as  he  will  require  in 
his  daily  walk,  by  no  means  discouragmg  him  from 
any  study  for  which  his  genius  fits  him  when  he 
once  feels  that  he  has  become  master  of  his  chosen  art. 
I  know  that  many  branches  of  science  are  of  the 
greatest  value  as  feeders  of  our  medical  reservoirs. 
But  the  practising  physician's  office  is  to  draw  the 
healmg  waters,  and  while  he  gives  his  time  to  this 
labor  he  can  hardly  be  expected  to  explore  all  the 
sources  that  spread  themselves  over  the  mde  domain 
of  science.  The  traveller  who  woidd  not  drink  of 
the  Nile  until  he  had  tracked  it  to  its  parent  lakes, 
would  be  like  to  die  of  thirst ;  and  the  medical  prac- 
titioner who  woidd   not   use   the   results    of  many 


INTRODUCTORY   LECTURE. 


laborers  in  other  departments  without  sharing  their 
special  toils,  would  find  life  far  too  short  and  art 
immeasurably  too  long. 

We  owe  much  to  Chemistry,  one  of  the  most  cap- 
tivating as  well  as  important  of  studies  ;  but  the 
medical  man  must  as  a  general  rule  content  himself 
with  a  clear  view  of  its  principles  and  a  limited 
acquaintance  with  its  facts  ;  such  especially  as  are 
pertinent  to  his  pursuits.  I  am  in  little  danger  of 
underrating  Anatomy  or  Physiology ;  but  as  each  of 
these  branches  splits  up  mto  specialties,  any  one  of 
which  may  take  up  a  scientific  life-time,  I  would  have 
them  taught  with  a  certain  judgment  and  reserve, 
so  that  they  shall  not  crowd  the  more  immediately 
practical  branches.  So  of  all  the  other  ancillary  and 
auxiliary  kinds  of  knowledge,  I  would  have  them 
strictly  subordinated  to  that  particular  kind  of  know- 
ledge for  which  the  community  looks  to  its  medical 
advisers. 

A  medical  school  is  not  a  scientific  school,  except 
just  so  far  as  medicine  itself  is  a  science.  On  the 
natural  history  side,  medicine  is  a  science  ;  on  the 
curative  side,  chiefly  an  art.  This  is  implied  in 
Hufeland's  aphorism :  "  The  physician  must  gene- 
ralize the  disease  and  individualize  the  patient." 

The  co-ordinated  and  classified  results  of  empirical 
observation^  in  distinction  from  scientific  experiment, 
have  furnished  almost  all  we  know  about  food,  the 
medicine  of  health,  and  medicine,  the  food  of  sick- 
ness. We  eat  the  root  of  the  Solanum  tuberosum 
and  throw  away  its  fruit;  we  eat  the  fruit  of  the 
Solanum  Li/copersicum   and    throw  away  its    root. 


6  INTRODtrCTORY   LECTURE. 

Nothing  but  vulgar  experience  has  taught  us  to 
reject  the  potato  ball  and  cook  the  tomato.  So  of 
most  of  om*  remedies.  The  subchloride  of  mercury, 
calomel,  is  the  great  British]  specific ;  the  protochlo- 
ride  of  mercury,  corrosive  subhmate,  kills  hke  arse- 
nic, but  no  chemist  could  have  told  us  it  would  be  so. 

From  observations  like  these  we  can  obtain  certain 
principles  from  which  we  can  argue  deductively  to 
facts  of  a  like  nature,  but  the  process  is  limited,  and 
we  are  suspicious  of  all  reasoning  in  that  direction 
apphed  to  the  processes  of  healthy  and  diseased 
life.  We  are  continually  appealing  to  special  facts. 
We  are  willing  to  give  Liebig's  artificial  milk  when 
we  cannot  do  better,  but  we  watch  the  child  anxiously 
whose  wet-nurse  is  a  chemist's  pipkm.  A  pair  of 
substantial  mammary  glands  has  the  advantage  over 
the  two  hemispheres  of  the  most  learned  Professor's 
brain,  in  the  art  of  compounding  a  nutritious  fluid 
for  infants. 

The  bedside  is  always  the  true  centre  of  medical 
teaching.  Certain  branches  must  be  taught  in  the 
lecture-room,  and  will  necessarily  involve  a  good  deal 
that  is  not  directly  useful  to  the  future  practitioner. 
But  the  over  ambitious  and  active  student  must  not  be 
led  away  by  the  seduction  of  knowledge  for  its  own 
sake  from  his  principal  pui'suit.  The  humble  begin- 
ner, who  is  alarmed  at  the  vast  fields  of  knowledge 
opened  to  him,  may  be  encoui'aged  by  the  assurance 
that  with  a  very  slender  provision  of  science,  in 
distinction  from  practical  skill,  he  may  be  a  useful 
and  acceptable  member  of  the  profession  to  which 
the  health  of  the  commimity  is  entrusted. 


INTRODUCTORY   LECTURE.  1 

To  those  who  are  not  to  engage  m  practice,  the 
various  piu'suits  of  science  hardly  require  to  be  com- 
mended. Only  they  must  not  be  disappouited  if  they 
find  many  subjects  treated  in  our  coui'ses  as  a  medical 
class  requhes,  rather  than  as  a  scientific  class  would 
expect,  that  is,  with  special,  limitations  and  constant 
reference  to  practical  ends.  Fortunately  they  are 
within  easy  reach  of  the  highest  scientific  instruction. 
The  business  of  a  school  like  this  is  to  make  useful 
working  physicians,  and  to  succeed  in  this  it  is 
almost  as  important  not  to  overcrowd  the  mind  of 
the  pupil  with  merely  curious  knowledge  as  it  is  to 
store  it  with  useful  uiformation. 

In  this  direction  I  have  written  my  lecture,  not  to 
undervalue  any  form  of  scientific  labor  in  its  place 
— an  imworthy  thought  from  which  I  hope  I  need 
not  defend  myself — but  to  discourage  any  undue 
inflation  of  the  scholastic  programme,  which  even 
now  asks  more  of  the  student  than  the  teacher  is  able 
to  obtain  from  the  great  majority  of  those  who  present 
themselves  for  examination.  I  wish  to  take  a  hint 
in  education  from  the  Secretary  of  the  Massachusetts 
Board  of  Agriculture,  who  regards  the  cultivation  of 
too  much  land  as  a  great  defect  in  our  New  England 
farming.  I  hope  that  our  Medical  Institutions  may 
never  lay  themselves  open  to  the  kmd  of  accusation 
IVIr.  Lowe  brings  against  the  Enghsh  Universities, 
when  he  says  that  their  education  is  made  up  "of 
words  that  few  understand  and  most  will  shortly 
forget ;  of  arts  that  can  never  be  used,  if  indeed  they 
can  even  be  learnt ;  of  histories  inapplicable  to  our 
times ;  of  languages  dead  and  even  mouldy ;  of  gram- 


O  INTRODUCTORY  LECTURE. 

matical  rules  that  ne\er  had  hvmg  use  and  are  only 
post  mortem  examuaations  ;  and  of  statements  faggoted 
with  utter  disregard  of  their  comparative  value." 

This  general  thought  will  be  kept  m  view  through- 
out my  somewhat  discursive  addi-ess,  which  Avill 
begin  with  an  imaginary  clhiical  lesson  from  the 
hps  of  an  historical  personage,  and  close  with  the 
portrait  from  real  life  of  one,  who  both  as  teacher 
and  practitioner  was  long  loved  and  honored  among 
us.  If  I  somewhat  over-rim  my  hour,  you  must 
pardon  me,  for  I  can  say  with  Pascal  that  I  have  not 
had  the  time  to  make  my  lecture  shorter. 


In  the  year  1647,  that  good  man  John  Eliot, 
commonly  called  the  Apostle  Eliot,  writing  to  IVIi'. 
Thomas  Shepherd,  the  pious  minister  of  Cambridge, 
referrmg  to  the  great  need  of  medical  instruction 
for  the  Indians,  used  these  Avords : 

"  I  have  thought  m  my  heart  that  it  were  a  singu- 
lar good  work,  if  the  Lord  woidd  stkre  up  the 
hearts  of  some  or  other  of  his  people  in  England  to 
give  some  mamtenance  toward  some  Schoole  or  Col- 
legiate exercise  this  way,  wherein  there  should  be 
Anatomies  and  other  instructions  that  way,  and 
where  there  might  be  some  recompence  given  to  any 
that  should  bring  in  any  vegetable  or  other  thing 
that  is  vertuous  in  the  way  of  Physick. 

"  There  is  another  reason  which  moves  my  thought 
and  deskes  this  way,  namely  that  our  young  students 
in  Physick  may  be  trained  up  better  then  they  yet 
bee,  who  have  onely  theoreticaU  knowledge,  and  are 
forced  to  fall  to  practise  before  ever  they  saw  an 


INTRODUCTORY   LECTURE.  9 

Anatomy  made,  or  duely  trained  up  in  making  ex- 
periments, for  we  never  had  bnt  one  Anatomy  in  the 
conntrey,  which  Mr.  Giles  Fnman  [Firmin]  now  in 
England,  did  make  and  read  upon  very  well,  but  no 
more  of  that  now." 

Since  the  time  of  the  Apostle  Eliot  the  Lord  has 
stuTed  up  the  hearts  of  our  people  to  the  building  of 
many  Schools  and  Colleges  where  medicine  is  taught 
in  all  its  branches.  ]\Ir.  Giles  Firmm's  "  Anatomy  " 
may  be  considered  the  first  ancestor  of  a  long  line  of 
skeletons  which  have' been  dangling  and  rattling  in 
our  lecture-rooms  for  more  than  a  century. 

Teaching  in  New  England  in  1647  was  a  grave 
but  simple  matter.  A  single  person,  combining  in 
many  cases,  as  in  that  of  Mr.  Giles  Firmui,  the 
offices  of  physician  and  preacher,  taught  what  he 
knew  to  a  few  disciples  whom  he  gathered  about 
him.  Of  the  making  of  that  "  Anatomy  "  on  which 
my  first  predecessor  in  the  branch  I  teach  "  did  read 
very  well "  we  can  know  nothmg.  The  body  of 
some  poor  wretch  who  had  swung  upon  the  gallows, 
was  probably  conveyed  by  night  to  some  lonely 
dwellmg  at  the  outskkts  of  the  village,  and  there  by 
the  light  of  flaring  torches  hastily  dissected  by  hands 
that  trembled  over  the  unwonted  task.  And  ever 
and  anon  the  master  turned  to  his  book,  as  he  laid 
bare  the  mysteries  of  the  hidden  organs  ;  to  his  pre- 
cious Vesahus,  it  might  be,  or  his  figures  repeated 
in  the  multifarious  volume  of  Ambrose  Pare  ;  to  the 
Aldine  octavo  in  which  Fallopius  recorded  his  fresh 
observations ;  or  that  giant  folio  of  Spigelius  just  issued 
from  the  press  of  Amsterdam,  in  which  lovely  ladies 
2 


10  INTRODUCTORY   LECTURE. 

display  their  viscera  with  a  coquettish  grace  implying 
that  it  is  rather  a  pleasure  than  otherwise  to  show 
the  lace-like  omentum,  and  hold  up  their  appendices 
ej^iploicae  as  if  they  were  saying  "  these  are  our  jewels." 

His  teachmg  of  medicine  was  no  doubt  chiefly 
clmical,  and  received  Avith  the  same  kind  of  faith  as 
that  which  accepted  his  words  from  the  pulpit.  His 
notions  of  disease  were  based  on  what  he  had  ob- 
served, seen  always  in  the  light  of  the  traditional 
doctrines  hi  which  he  was  bred.  His  discourse  sa- 
vored of  the  weighty  doctrines  of  Hippocrates,  dilut- 
ed by  the  subtle  speculations  of  Galen,  reinforced 
by  the  curious  comments  of  the  Arab  schoolmen 
as  they  were  conveyed  in  the  mellifluous  language 
of  Fernelius,  blended,  it  may  be,  with  somethmg 
of  the  lofty  mysticism  of  Van  Helmont,  and  perhaps 
stealing  a  flavor  of  that  earlier  form  of  Homoeopathy 
w^hich  had  lately  come  to  light  in  Sir  Kenelm  Digby's 
"  Discourse  concerning  the  Cure  of  Wounds  by  the 
Sympathetic  Powder." 

His  Pathology  was  mythology.  A  malformed 
foetus,  as  the  readers  of  Winthrop's  Journal  may 
remember,  was  enough  to  scare  the  colonists  from 
theii'  propriety,  and  suggest  the  gravest  fears  of  por- 
tended disaster.  The  student  of  the  seventeenth 
century  opened  his  Licetus  and  saw  figures  of  a  lion 
with  the  head  of  a  woman,  and  a  man  with  the  head 
of  an  elephant.  He  had  offered  to  his  gaze,  as  born 
of  a  human  mother,  the  effigy  of  a  winged  cherub, 
a  pterocephalous  specimen,  which  our  Professor  of 
Pathological  Anatomy  would  hardly  know  whether  to 
treat  with  the  reverence  due  to  its  celestial  aspect, 


INTRODUCTORY   LECTURE.  11 

or  to  imprison  in  one  of  his  immortalizing  jars  of 
alcohol. 

His  pharmacopoeia  consisted  mainly  of  simples, 
such  as  the  venerable  "  Herball"  of  Gerard  describes 
and  figures  in  abounding  affluence.  St.  John's  wort 
and  Clown's  All-heal,  with  Spurge  and  Fennel,  Saffron 
and  Parsley,  Elder  and  Snake-root,  "with  opium  in 
some  form,  and  roasted  rhubarb  and  the  Four  Great 
Cold  Seeds,  and  the  two  Resins,  of  which  it  used  to 
be  said  that  whatever  the  Tacamahaca  has  not  cured, 
the  Caranna  will,  mth  the  more  familiar  Scammony 
and  Jalap  and  Black  Hellebore,  made  up  a  good 
part  of  his  probable  list  of  remedies.  He  would  have 
ordered  Iron  now  and  then,  and  possibly  an  occa- 
sional dose  of  Antimony.  He  would  perhaps  have 
had  a  rheumatic  patient  wrapped  in  the  skin  of  a 
wolf  or  a  wild  cat,  and  in  case  of  a  malignant  fever 
with  "  purples  "  or  petechias,  or  of  an  obstinate  king's 
evil,  he  might  have  prescribed  a  certain  black  powder, 
which  had  been  made  by  calcining  toads  in  an  earthen 
pot ;  a  choice  remedy,  taken  internally,  or  applied  to 
any  outward  grief. 

Except  for  the  toad-powder  and  the  peremptory 
drastics,  one  might  have  borne  up  against  this  herb- 
doctoring  as  well  as  against  some  more  modern  styles 
of  medication.  Barbeyrac  and  his  scholar  Sydenham 
had  not  yet  cleansed  the  Pharmacopoeia  of  its  perilous 
stuff,  but  there  is  no  doubt  that  the  more  sensible 
physicians  of  that  day  knew  well  enough  that  a  good 
honest  herb-tea  which  amused  the  patient  and  his 
nurses  was  all  that  was  required  to  carry  him  through 
all  common  disorders. 


12  INTEODUCTORY  LECTURE. 

The  student  soon  learned  the  physiognomy  of  dis- 
ease by  going  about  \\ith  his  master ;  fevers,  pleuri- 
sies, asthmas,  dropsies,  fluxes,  small-pox,  sore-throats, 
measles,  consumptions.  He  saw  what  was  done  for 
them.  He  put  up  the  medicines,  gathered  the  herbs, 
and  so  learned  sometliing  of  materia  medica  and 
botany.  He  learned  these  few  things  easily  and  well, 
for  he  could  give  his  whole  attention  to  them.  Chi- 
rurgery  was  a  separate  specialty'.  Women  in  child- 
birth w^ere  cared  for  by  midmves.  There  was  no 
chemistry  deserving  the  name  to  require  his  study. 
He  did  not  learn  a  great  deal,  perhaps,  but  what  he 
did  learn  was  his  business,  namely,  how  to  take  care 
of  sick  people. 

Let  me  give  you  a  pictui-e  of  the  old  fashioned  way 
of  instruction,  by  carrying  you  with  me  in  imagination 
in  the  company  of  worthy  Master  Giles  Fu'min  as  he 
makes  his  round  of  visits  among  the  good  folk  of 
Ipsmch,  followed  by  his  one  student,  who  shall  an- 
swer to  the  scriptural  name  of  Luke.  It  "will  not  be 
for  entertainment  chiefly,  but  to  illustrate  the  one 
mode  of  teaching  which  can  never  be  superseded,  and 
which,  I  ventui-e  to  say,  is  more  important  than  all 
the  rest  put  together.  The  student  is  a  green  hand, 
as  you  will  perceive. 

In  the  first  dwelling  they  come  to,  a  stout  fellow 
is  bellowing  with  cohc. 

"  He  will  die,  Master,  of  a  surety,  methinks,"  says 
the  timid  youth  in  a  whisper. 

"  Nay,  Luke,"  the  Master  answers,  "  'tis  but  a  dry 
bcUy-achc.  Dids't  thou  not  mark  that  he  stayed  his 
roaring  when  I  did  press  hard  over  the  lesser  bowels  ? 


INTEODUCTORY   LECTURE.  13 

Note  that  he  hath  not  the  pulse  of  them  with  fevers, 
and  by  what  Dorcas  telleth  me  there  hath  been  no  long 
shuttmg  up  of  the  vice  naturales.  We  will  steep  cer- 
tain comforting  herbs  which  I  will  shew  thee,  and  put 
them  in  a  bag  and  lay  them  on  his  belly.  Likewise 
he  shall  have  my  cordial  julep  with  a  portion  of  this 
confection  which  we  do  call  Theriaca  Andromachi, 
which  hath  juice  of  poppy  in  it,  and  is  a  great  stayer 
of  anguish.  This  fellow  is  at  his  prayers  to-day,  but 
I  warrant  thee  he  shall  be  swearing  with  the  best  of 
them  to-morrow." 

They  jog  along  the  bridle-path  on  then*  horses 
until  they  come  to  another  lowly  dwelling.  They  sit 
awhile  with  a  delicate  looking  girl  m  whom  the 
ingenuous  youth  naturally  takes  a  special  interest. 
The  good  physician  talks  cheerfully  with  her,  asks 
her  a  few  questions.  Then  to  her  mother  :  "  Good- 
wife,  Margaret  hath  somewhat  profited,  as  she  telleth, 
.  by  the  goat's  milk  she  hath  taken  night  and  morning. 
Do  thou  pluck  a  maniple — that  is  an  handful — of 
the  plant  called  Maidenliau',  and  make  a  syrup 
therewith  as  I  have  shewed  thee.  Let  her  take  a 
cup  full  of  the  same,  fasting,  before  she  sleepeth, 
also  before  she  riseth  from  her  bed."  And  so  they 
leave  the  house. 

"  What  thinkest  thou,  Luke,  of  the  maid  we  have 
been  \dsiting'?"  "She  seemeth  not  much  ailmg. 
Master,  according  to  my  poor  judgment.  For  she 
did  say  she  was  better.  And  she  had  a  red  cheek 
and  a  bright  eye,  and  she  spake  of  being  soon  able  to 
walk  unto  the  meeting,  and  did  seem  greatly  hopeful, 
but  spare  of  flesh,  methought,  and  her  voice  some- 


14  INTRODUCTORY   LECTURE. 

thing  hoarse,  as  of  one  that  hath  a  defluxion,  with 
some  small  conghing  from  a  cold,  as  she  did  say. 
Speak  I  not  truly,  Master,  that  she  will  be  well 
speedily  ? " 

"  Yea,  Luke,  I  do  think  she  shall  be  well,  and 
mayhap  speedily.  But  it  is  not  here  ^^ith  us  she 
shall  be  well.  For  that  redness  of  the  cheek  is  but 
the  sign  of  the  fever  which,  after  the  Grecians,  we 
do  call  the  hectical ;  and  that  shining  of  the  eyes  is 
but  a  sickly  glazing,  and  they  which  do  every  day  get 
better  and  hkewise  thinner  and  weaker  shall  find 
that  way  leadeth  to  the,  chiu'ch-yard  gate.  This  is 
the  malady  which  the  ancients  did  call  tabes^  or  the 
wasting  disease,  and  some  do  name  the  consumption. 
A  disease  whereof  most  that  fall  ailmg  do  perish. 
This  Margaret  is  not  long  for  earth — but  she  know- 
eth  it  not,  and  still  hopeth." 

"  A'NTiy,  then.  Master,  didst  thou  give  her  of  thy 
medicine,  seeing  that  her  ail  is  unto  death'? " 

"  Thou  shalt  learn,  boy,  that  they  which  are 
sick  must  have  somewhat  wherewith  to  busy  their 
thoughts.  There  be  some  who  do  give  these  tabid  or 
consumptives  a  certain  posset  made  mth  hme-water 
and  anise  and  liquorice  and  raisins  of  the  sim,  and 
there  be  other  some  who  do  give  the  juice  of  craw- 
fishes boiled  in  barley-water  with  chicken-broth,  but 
these  be  toys,  as  I  do  think,  and  ye  shall  find  as  good 
TTL'tue,  nay  better,  in  this  syrup  of  the  simple  called 
Maidenhair." 

Something  after  this  manner  might  ]\Iaster  Giles 
Firmm  have  delivered  his  clinical  mstriTctions.  Some- 
what in  this  -svay,  a  century  and  a  half  later,  another 


INTEODUCTORT   LECTURE.  15 

New  England  physician,  Dr.  Edward  Augustus  Hol- 
yoke,  taught  a  young  man  who  came  to  study  with 
him,  a  very  diUgent  and  intelligent  youth,  James 
Jackson  by  name,  the  same  whose  portrait  in  his 
advanced  years  hangs  upon  this  wall,  long  the  honor- 
ed Professor  of  Theory  and  Practice  in  this  Institution, 
of  whom  I  shall  say  something  in  this  Lecture.  Our 
venerated  Teacher  studied  assiduously  afterwards  in 
the  great  London  Hospitals,  but  I  thmk  he  used  to 
quote  his  "  old  Master  "  ten  times  where  he  quoted 
Mr.  Cline  or  Dr.  Woodville  once. 

When  I  compare  this  dkect  transfer  of  the  prac- 
tical experience  of  a  wise  man  into  the  mind  of  a 
student — every  fact  one  that  he  can  use  in  the  battle 
of  life  and  death — with  the  far  off,  unserviceable 
"  scientific  "  truths  that  I  and  some  others  are  in  the 
habit  of  teaching,  I  cannot  help  asking  myself  whether, 
if  we  concede  that  our  forefathers  taught  too  little,  there 
is  not  a  possibility  that  we  may  sometimes  attempt  to 
teach  too  much.  I  almost  blush  when  I  think  of 
myself  as  describing  the  eight  several  facets  on  two 
slender  processes  of  the  palate  bone,  or  the  seven 
little  twigs  that  branch  off  from  the  mmute  tympanic 
nerve,  and  I  wonder  whether  my  excellent  colleague 
feels  in  the  same  way  when  he  pictures  himself  as 
giving  the  constitution  of  neurin,  which  as  he  and  I 
know  very  well  is  that  of  the  hydrate  of  trimethyle- 
oxethyle-ammonium,  or  the  formula  for  the  production 
of  alloxan,  which,  though  none  but  the  Professors 
and  older  students  can  be  expected  to  remember  it, 
is  Cio  H4  N,  Oe+2  HO,  N05}=C8  H,  N^  0^0+2  CO, 
+N2  +NH,  O,  NO5. 


16  INTRODUCTORY  LECTURE. 

I  can  hear  the  voice  of  some  rough  iconoclast  ad- 
dressing the  Anatomist  and  the  Chemist  in  tones  of 
contemptuous  indignation :  "  What  is  this  stuff  with 
which  you  are  cramming  the  brains  of  young  men 
who  are  to  hold  the  hves  of  the  commimity  in  their 
hands  ?  Here  is  a  man  fallen  in  a  fit ;  you  can  tell 
me  all  about  the  eight  surfaces  of  the  two  processes 
of  the  palate-bone,  but  you  have  not  had  the  sense  to 
loosen  that  man's  neck-cloth,  and  the  old  women  are 
all  calling  you  a  fool  ?  Here  is  a  fellow  that  has  just 
swallowed  poison.  I  want  something  to  turn  his 
stomach  inside  out  at  the  shortest  notice.  O,  you 
have  forgotten  the  dose  of  the  sulphate  of  zinc,  but 
you  remember  the  formula  for  the  production  of 
alloxan !  " 

"  Look  you,  Master  Doctor — if  I  go  to  a  carpenter 
to  come  and  stop  a  leak  in  my  roof  that  is  flooding 
the  house,  do  you  suppose  I  care  whether  he  is  a 
botanist  or  not  ]  Cannot  a  man  work  in  wood  without 
knowing  all  about  endogens  and  exogens,  or  must 
he  attend  Professor  Gray's  Lectures  before  he  can  be 
trusted  to  make  a  box-trap  ?  If  my  horse  casts  a 
shoe,  do  you  thmk  I  will  not  trust  a  blacksmith  to 
shoe  him  until  I  have  made  sure  that  he  is  sound  on 
the  distinction  between  the  sesquioxide  and  the  proto- 
sesquioxide  of  iron  ?  " 

— But  my  scientific  labor  is  to  lead  to  usefid  residts 
by  and  by,  in  the  next  generation,  or  in  some  possible 
remote  future. — 

"  Diavolo  !  "  as  your  Dr.  Rabelais  has  it, — answers 
the  iconoclast — "  what  is  that  to  me  and  my  colic,  to 
me  and  my  strangm-y  ]        I  pay  the  Captain  of  the 


INTRODUCTORY   LECTURE.  IT 

Cunard  steamship  to  carry  me  quickly  and  safely  to 
Liverpool,  not  to  make  a  chart  of  the  Atlantic  for 
after  voyagers !  K  Professor  Pierce  undertakes  to 
pilot  me  into  Boston  Harbor  and  runs  me  on  Cohasset 
rocks,  what  answer  is  it  to  tell  me  that  he  is  Superin- 
tendent of  the  Coast  Siu'vey  ?  No,  Su' !  I  want  a  plain 
man  in  a  pea-jacket  and  a  sou'wester,  who  knows 
the  channel  of  Boston  Harbor,  and  the  rocks  of 
Boston  Harbor,  and  the  distmguished  Professor  is 
quite  of  my  mind  as  to  the  matter,  for  I  took  the 
pains  to  ask  him  before  I  ventured  to  use  his  name 
in  the  way  of  illustration." 

I  do  not  know  how  the  remarks  of  the  image- 
breaker  may  strike  others,  but  I  feel  that  they  put 
me  on  my  defence  with  regard  to  much  of  my  teach- 
ing. Some  years  ago  I  ventured  to  show  in  an  uitro- 
ductory  Lecture  how  very  small  a  proportion  of  the 
anatomical  facts  taught  in  a  regular  course  as  deli- 
vered by  myself  and  others,  had  any  practical  bearing 
whatever  on  the  treatment  of  disease.  How  can  I, 
how  can  any  medical  teacher  justify  himself  in  teach- 
ing anything  that  is  not  like  to  be  of  practical  use  to 
a  class  of  young  men  who  are  to  hold  in  their  hands 
the  balance  in  which  life  and  death,  ease  and  anguish, 
happiness  and  wretchedness  are  to  be  daily  weighed '? 

I  hope  we  are  not  all  wrong.  Oftentimes  in  finding 
how  sadly  ignorant  of  really  essential  and  vital  facts 
and  rules  were  some  of  those  whom  we  had  been 
lardhig  with  the  choicest  scraps  of  science,  I  have 
doubted  whether  the  old  one-man  system  of  teaching, 
when  the  one  man  was  of  the  right  sort,  did  not  turn 
out  better  working  physicians  than  our  more  elabo- 
3 


18  INTEODUCTORY  LECTURE. 

rate  method.  The  best  practitioner  I  ever  knew  was 
mainly  shaped  to  excellence  in  that  way.  I  can  im- 
derstand  perfectly  the  regrets  of  my  friend  Dr.  John 
Brown  of  Edinburgh,  for  the  good  that  was  lost  with 
the  old  apprenticeshij)  system.  I  imderstand  as  well 
Dr.  Latham's  fear  "  that  many  men  of  the  best  abili- 
ties and  good  education  will  be  deterred  from  prose- 
cuting physic  as  a  profession,  m  consequence  of  the 
necessity  indiscriminately  laid  upon  aU  for  impossible 
attainments." 

I  feel  therefore  impelled  to  say  a  very  few  words 
in  defence  of  that  system  of  teaching  adopted  in  our 
Colleges,  by  which  we  wish  to  supplement  and  com,- 
plete  the  instruction  given  by  private  individuals  or 
by  what  are  often  called  Summer  Schools. 

The  reason  why  we  teach  so  much  that  is  not 
practical  and  in  itself  useful,  is  because  we  fitid  that 
the  easiest  way  of  teachmg  what  is  practical  and 
useful.  If  we  could  m  any  way  eliminate  all  that 
would  help  a  man  to  deal  successfully  with  disease, 
and  teach  it  by  itself  so  that  it  should  be  as  tena- 
ciously rooted  in  the  memory,  as  easily  summoned 
when  wanted,  as  fertile  in  suggestion  of  related  facts, 
as  satisfactory  to  the  peremptory  demands  of  the 
mtelligence  as  if  taught  in  its  scientific  comiections, 
I  think  it  would  be  our  duty  so  to  teach  the  moment- 
ous truths  of  medicine,  and  to  regard  all  useless 
additions  as  an  intrusion  on  the  time  which  should 
be  otherwise  occupied. 

But  we  camiot  successfully  eliminate  and  teach  by 
itself  that  which  is  purely  practical.  The  easiest 
and  surest  way  of  acquiiing  facts  is  to  learn  them  in 


INTEODUCTORY   LECTURE.  19 

groups,  in  systems,  and  systematized  knowledge  is 
science.  You  can  very  often  carry  t\yo  facts  fastened 
together  more  easily  than  one  by  itself,  as  a  housiemaid 
can  carry  two  pails  of  watej  with  a  hoop  more  easily 
than  one  without  it.  You  can  remember  a  man's  face, 
made  up  of  many  features,  better  than  you  can  his  nose 
or  his  mouth  or  his  eye-brow.  Scores  of  proverbs 
show  you  that  you  can  remember  two  lines  that  rhyme 
better  than  one  without  the  jingle.  The  ancients, 
who  knew  the  laws  of  memory,  grouped  the  seven 
cities  that  contended  for  the  honor  of  being  Homer's 
birth-place  in  a  line  thus  given  by  Aulus  Gellius  : 

Smurna,  Rodos,  Colophon,  Salamin,  los,  Argos,  Athenai. 

I  remember,  in  the  earlier  political  days  of  Martin 
Van  Buren,  that  Colonel  Stone,  of  the  New  York 
Commercial,  or  one  of  his  correspondents,  said  that 
six  towns  of  New  York  would  Claim  in  the  same  way 
to  have  been  the  bkth-place  of  the  "  Little  Magician," 
as  he  was  then  called ;  and  thus  he  gave  their  names, 
any  one  of  which  I  should  long  ago  have  forgotten, 
but  which  as  a  group  have  stuck  tight  in  my  memory 
from  that  day  to  this : 

Catskill,  Saugerties,  Redhook,  Kinderhook,  ScagMicoke,  Schodac. 

If  the  memory  gains  so  much  by  mere  rhythmical 
association,  how  much  more  will  it  gain  when  isolated 
facts  are  brought  together  under  laws  and  principles, 
when  organs  are  examined  in  their  natural  connections, 
when  structiu'e  is  coupled  with  function,  and  healthy 
and  diseased  action  are  studied  as  they  pass  one  into 
the  other !  Systematic,  or  scientific  study  is  invalua- 
ble as  supplying  a  natural  kind  of  mnemonics,  if  for 


20  mTRODUCTOEY   LECTURE. 

nothing  else.  You  cannot  properly  learn  the  facts 
you  want  from  Anatomy  and  Chemistry  in  any  way 
so  easily  as  by  taking  them  in  their  regular  order, 
with  other  allied  facts,  only  there  must  be  common 
sense  exercised  in  leaAdng  out  a  great  deal  w^hich 
belongs  to  each  of  the  two  branches  as  pure  science. 
The  dullest  of  teachers  is  the  one  who  does  not 
know  what  to  omit. 

The  larger  aim  of  scientific  training  is  to  furnish 
you  with  principles  to  which  you  will  be  able  to  refer 
isolated  facts,  and  so  bring  these  within  the  range  of 
recorded  experience.  See  what  the  London  Times 
said  about  the  three  Germans  who  cracked  open  John 
Bull  Chatwood's  strong-box  at  the  Fail'  the  other  day, 
while  the  three  Englishmen  hammered  away  in  vain 
at  Brother  Jonathan  Herring's.  The  Englishmen 
represented  brute  foj:ce.  The  Germans  had  been 
trained  to  appreciate  principle.  The  Englishman 
"knows  his  business  by  rote  and  rule  of  thumb" — 
science,  which  woidd  "  teach  him  to  do  in  an  hour 
what  has  hitherto  occupied  him  two  houi's,"  "is  in  a 
manner  forbidden  to  him."  To  this  cause  the  Times 
attributes  the  fallmg  off  of  English  workmen  in  com- 
parison with  those  of  the  Continent. 

Grantmg  all  this,  we  must  not  expect  too  much 
from  "  science  "  as  distmguished  from  common  expe- 
rience. There  are  ten  thousand  exj^erimenters  with- 
out special  apparatus  for  every  one  in  the  laboratory. 
Accident  is  the  great  chemist  and  toxicologist.  Bat- 
tle is  the  great  vivisector.  Hunger  has  instituted 
researches  on  food  such  as  no  Liebig,  no  Academic 
Commission  has  ever  recorded. 


INTRODUCTOEY   LECTURE.  21 

Medicine,  sometimes  impertinently,  often  ignorant- 
ly,  often  carelessly  called  "  allopathy,"  appropriates 
everything  from  every  source  that  can  be  of  the 
slightest  use  to  anybody  who  is  ailing  in  any  way,  or 
like  to  be  ailing  from  any  cause.  It  learned  from  a 
monk  how  to  use  antimony,  from  a  Jesuit  how  to 
ciu'e  agues,  from  a  friar  how  to  cut  for  stone,  from  a 
soldier  how  to  treat  gout,  from  a  sailor  how  to  keep 
off  scurvy,  from  a  post-master  how  to  sound  the 
Eustachian  tube,  from  a  dairy-maid  how  to  prevent 
small-pox,  and  from  an  old  market-woman  how  to 
catch  the  itch-insect.  It  borrowed  acupuncture  and 
the  moxa  from  the  Japanese  heathen,  and  was  taught 
the  use  of  lobelia  by  the  American  savage.  It 
stands  ready  to-day  to  accept  anything  from  any 
theorist,  from  any  empiric  who  can  make  out  a  good 
case  for  his  discovery  or  his  remedy.  "  Science  "  is 
one  of  its  benefactors,  but  only  one,  out  of  many. 
Ask  the  wisest  practising  physician  you  know,  what 
branches  of  science  help  him  habitually,  and  what 
amount  of  knowledge  relating  to  each  branch  he 
requires  for  his  professional  duties.  He  will  teU  you 
that  scientific  training  has  a  value  mdependent  of  aU 
the  special  knowledge  acquired.  He  will  tell  you 
that  many  facts  are  explained  by  studying  them  in 
the  wider  range  of  related  facts  to  which  they  belong. 
He  will  gratefully  recognize  that  the  anatomist  has 
furnished  him  with  indispensable  data,  that  the 
physiologist  has  sometimes  put  him  on  the  track  of 
noAV  modes  of  treatment,  that  the  chemist  has  isolated 
the  active  prmciples  of  his  medicines,  has  taught  him 
how  to  combine  them,  has  from  time  to  time  offered 


22  INTRODUCTORY   LECTURE. 

him  new  remedial  agencies,  and  so  of  others  of  his 
aUies.  But  he  Avill  also  tell  you,  if  I  am  not  mistaken, 
that  his  o^vn  branch  of  knowledge  is  so  extensive  and 
so  }3erplexing  that  he  must  accept  most  of  his  facts 
ready  made  at  their  hands.  He  ■v\'ill  own  to  you  that 
in  the  struggle  for  life  which  goes  on  day  and  night 
in  our  thoughts  as  in  the  outside  world  of  nature, 
much  that  he  learned  under  the  name  of  science  has 
died  out,  and  that  simple  homely  experience  has 
largely  taken  the  place  of  that  scholastic  knowledge 
to  which  he  and  perhaps  some  of  his  instructors  once 
attached  a  paramount  importance. 

This,  then,  is  my  view  of  scientific  training  as  con- 
ducted in  courses  such  as  you  are  entering  on.  Up 
to  a  certain  point  I  believe  in  set  Lectures  as  excel- 
lent adjuncts  to  what  is  far  more  important,  practical 
instruction  at  the  bed-side,  m  the  operating  room, 
and  under  the  eye  of  the  Demonstrator.  But  I  am 
so  far  from  wishing  these  courses  extended,  that  I 
think  some  of  them — suppose  I  say  my  otmi — would 
almost  bear  curtailing.  Do  you  want  me  to  describe 
more  branches  of  the  sciatic  and  crural  nerves  ?  I 
can  take  Fischer's  plates,  and  lecturmg  on  that  scale 
fill  up  my  whole  course  and  not  finish  the  nerves 
alone.  We  must  stop  somewhere,  and  for  my  own 
part  I  think  the  scholastic  exercises  of  our  colleges 
have  already  claimed  their  full  share  of  the  student's 
time  without  our  seeking  to  extend  them. 

I  trust  I  have  •\indicated  the  aj)parent  inconse- 
quence of  teaching  young  students  a  good  deal  that 
seems  at  first  sight  profitless,  but  which  helps  them 
to  learn  and  retam  what  is  profitable.     But  this  is  an 


INTRODUCTORY   LECTURE.  23 

inquisitive  age,  and  if  we  insist  on  piling  up  beyond 
a  certain  height  knowledge  which  is  in  itself  mere 
trash  and  lumber  to  a  man  whose  life  is  to  be  one 
long  fight  with  death  and  disease,  there  will  be  some 
sharp  questions  asked  by  and  by,  and  our  quick- 
witted people  will  perhaps  find  they  can  get  along 
as  Avell  without  the  professor's  cap  as  without  the 
bishop's  mitre  and  the  monarch's  crown. 

I  myself  have  nothing  to  do  with  clinical  teaching. 
Yet  I  do  not  hesitate  to  say  it  is  more  essential  than 
all  the  rest  put  together,  so  far  as  the  ordinary  prac- 
tice of  medicine  is  concerned ;  and  this  is  by  far  the 
most  important  thing  to  be  learned,  because  it  deals 
with  so  many  more  lives  than  any  other  branch  of  the 
profession.  So  of  personal  instruction,  such  as  we 
give  and  others  give  in  the  interval  of  lectures,  much 
of  it  at  the  bedside,  some  of  it  m  the  laboratory,  some 
in  the  microscope-room,  some  in  the  recitation-room, 
I  think  it  has  many  advantages  of  its  own  over  the 
winter  course,  and  I  do  not  wish  to  see  it  shortened 
for  the  sake  of  prolonging  what  seems  to  me  long 
enough  already. 

If  I  am  jealous  of  the  tendency  to  expand  the 
time  given  to  the  acquisition  of  curious  knowledge, 
at  the  expense  of  the  plain  old-fashioned  bed-side 
teachings,  I  only  share  the  feeling  which  Sydenham 
expressed  two  hundred  years  ago,  using  an  image 
I  have  already  borrowed.  "  He  would  be  no  honest 
and  successful  pilot  who  was  to  apply  himself 
with  less  industry  to  avoid  rocks  and  sands  and 
bring  his  vessel  safely  home,  than  to  search  into  the 
causes  of  the  ebbing  and  flowing  of  the  sea,  which, 


24  INTRODUCTORY  LECTURE. 

thougli  very  well  for  a  philosopher,  is  foreign  to 
him  -whose  business  it  is  to  secure  the  ship.  So 
neither  will  a  physician,  whose  province  it  is  to  cure 
diseases,  be  able  to  do  so,  though  he  be  a  person  of 
great  genius,  Avho  bestows  less  time  on  the  hidden 
and  intricate  method  of  nature,  and  adaptmg  his 
means  thereto,  than  on  curious  and  subtle  specula- 
tion." 

"  Medicine  is  my  wife  and  Science  is  my  mistress," 
said  Dr.  Rush.  I  do  not  think  that  the  breach  of  the 
seventh  commandment  can  be  shown  to  have  been  of 
advantage  to  the  legitimate  owner  of  his  affections. 
Read  what  Dr.  Elisha  Bartlett  says  of  him  as  a  x^rac- 
titioner,  or  ask  one  of  our  own  honored  Ex-Professors, 
who  studied  under  him,  whether  Dr.  Rush  had  ever 
learned  the  meaning  of  that  saving  of  Lord  Bacon 
that  man  is  the  minister  and  interpreter  of  Nature,  or 
whether  he  did  not  speak  habitually  of  Nature  as  an 
intruder  in  the  sick  room^  from  which  his  art  was  to 
expel  her  as  an  mcompetent  and  a  meddler. 

All  a  man's  powers  are  not  too  much  for  such  a 
profession  as  Medicine.  "  He  is  a  learned  man,"  said 
old  Parson  Emmons  of  Franklin,  "  who  imderstands 
one  subject,  and  he  is  a  very  learned  man  who 
understands  two  subjects."  Schonbein  says  he  has 
been  stud^dng  oxygen  for  thirty  years.  jSIitscherhch 
said  it  took  fourteen  years  to  establish  a  new  fact  in 
chemistry.  Aubrey  says  of  Harvey,  the  discoverer 
of  the  circulation,  that  "  though  all  his  profession 
would  allow  him  to  be  an  excellent  anatomist,  I 
have  never  heard  of  any  who  admued  his  therapeutic 
way."     My  learned  and  excellent  friend  before  re- 


INTRODUCTORY   LECTURE.  25 

ferred  to,  Dr.  Brown  of  Edinburgh,  from  whose  very 
lively  and  sensible  Essay,  "  Locke  and  Sydenham," 
I  have  borrowed  several  of  my  citations,  contrasts 
Sir  Charles  Bell,  the  discoverer,  the  man  of  science, 
with  Dr.  Abercrombie,  the  master  in  the  diagnosis  and 
treatment  of  disease.  It  is  through  one  of  the  rarest 
of  combmations  that  we  have  in  our  Faculty  a  teacher 
on  whom  the  scientific  mantle  of  Bell  has  fallen,  and 
who  yet  stands  preeminent  in  the  practical  treatment 
of  the  class  of  diseases  which  his  inventive  and  ar- 
dent experimental  genius  has  illustrated.  M.  Brown- 
Sequard's  example  is  as  eloquent  as  his  teaching  in 
proof  of  the  advantages  of  well  dnected  scientific 
investigation.  But  those  who  emulate  his  success  at 
once  as  a  discoverer  and  a  practitioner,  must  be  con- 
tent like  him  to  limit  their  field  of  practice.  The 
highest  genius  cannot  afibrd  in  our  time  to  forget  the 
ancient  precept.  Divide  et  impera. 

"  I  suppose  I  must  go  and  earn  this guinea," 

said  a  medical  man  who  was  sent  for  while  he  was 
dissecting  an  animal.  I  shoidd  not  have  cared  to  be 
his  patient.  His  dissection  would  do  me  no  good, 
and  his  thoughts  would  be  too  much  upon  it.  I  want 
a  whole  man  for  my  doctor,  not  a  half  one.  I  would 
have  sent  for  a  humbler  practitioner,  who  would  have 
given  himself  entkely  to  me,  and  told  the  other — 
who  was  no  less  a  man  than  John  Hunter — to  go  on 
and  finish  the  dissection  of  liis  tiger. 

Sydenham's  "  Read  Don  Quixote  "  should  be  ad- 
dressed not  to  the  student,  but  to  the  Professor  of 
to-day.  Aimed  at  him  it  means,  "  Do  not  be  too 
learned.  Do  not  think  you  are  going  to  lecture  to 
4 


26  miRODUCTOEY   LECTURE. 

picked  yomig  men  who  are  training  themselves  to  be 
scientific  discoverers.  They  are  of  fah  average 
capacity,  and  they  are  going  to  be  working  doctors." 

These  young  men  are  to  have  some  very  serious 
vital  facts  to  deal  mth.    I  will  mention  a  few  of  them. 

Every  other  resident  adult  you  meet  in  these 
streets  is  or  will  be  more  or  less  tuberculous.  This 
is  not  an  extravagant  estimate,  as  very  nearly  one- 
thu'd  of  the  deaths  of  adults  in  Boston  last  year  were 
from  phthisis.*  If  the  relative  number  is  less  in  our 
other  northern  cities,  it  is  probably  in  a  great  measure 
because  they  are  more  unhealthy ;  that  is,  they  have 
as  much,  or  nearly  as  much  consumption,  but  they 
have  more  fevers  or  other  fatal  diseases. 

These  heavy-eyed  men  va\h  the  alcoholized  brains, 
these  pallid  youths  with  the  nicotized  optic  ganglia  and 
thmkmg-marrows  brown  as  theu*  own  meerschaums, 
— of  whom  you  meet  too  many, — will  ask  all  your 
wisdom  to  deal  with  their  poisoned  nerves  and  their 
enfeebled  wills. 

Nearly  seventeen  hundi-ed  children  under  five  years 
of  age  died  last  year  in  this  city.  A  poor  human 
article,  no  doubt,  m  many  cases,  still,  worth  an  attempt 
to  save  them,  especially  when  we  remember  the  effect 
of  Dr.  Clarke's  suggestion  at  the  Dublm  Hospital,  by 
which  some  twenty-five  or  thhty  thousand  children's 
lives  have  probably  been  saved  in  a  single  city. 

Again,  the  complaint  is  often  heard  that  the  native 
population  is  not  increasing  so  rapidly  as  in  former  gen- 
erations. The  breeding  and  nursing  period  of  Ameri- 
1 — ■ — . 

*  Total  number  of  deaths,  4379 ;  under  20  years,  2109 ;  over  20  j-ears,  2270. 
From  phthisis,  846;  under  20  years,  146;  over  20  years,  700. 


INTRODUCTORY   LECTURE.  27 

can  women  is  one  of  peculiar  delicacy  and  frequent 
infirmity.  Many  of  them  must  require  a  considerable 
interval  between  the  reproductive  efforts,  to  repair 
damages  and  regain  strength.  This  matter  is  not  to 
be  decided  by  an  appeal  to  unschooled  nature.  It  is 
the  same  question  as  that  of  the  deformed  pelvis — 
one  of  degree.  The  facts  of  mal-vitalization  are  as 
much  to  be  attended  to  as  those  of  mal-formation. 
If  the  woman  with  a  twisted  pelvis  is  to  be  consider- 
ed an  exempt,  the  woman  with  a  defective  organiza- 
tion should  be  recognized  as  belonging  to  the  invalid 
corps.  We  shudder  to  hear  what  is  alleged  as  to 
the  prevalence  of  criminal  practices  ;  if  back  of  these 
there  can  be  shown  organic  incapacity  or  overtaxing 
of  too  limited  powers,  the  facts  belong  to  the  province 
of  the  practical  physician,  as  well  as  of  the  moralist 
and  the  legislator,  and  require  his  gravest  consi- 
deration. 

Take  the  important  question  of  bleedmg.  Is  vene- 
section done  with  forever  ?  Six  years  ago  it  was  said 
here  in  an  introductory  Lecture  that  it  would  doubt- 
less come  back  again  sooner  or  later.  A  fortnight 
ago  I  found  myself  in  the  cars  with  one  of  the  most 
sensible  and  esteemed  practitioners  in  New  England. 
He  took  out  his  wallet  and  showed  me  two  lancets, 
which  he  carried  with  him ;  he  had  never  given  up 
their  use.     This  is  a  point  you  will  have  to  consider. 

Or,  to  mention  one  out  of  many  questionable  reme- 
dies, shall  you  give  Veratrum  Viride  in  fevers  and 
inflammations  ?  It  makes  the  pulse  slower  in  these 
affections.  Then  the  presumption  would  naturally 
be  that  it  does  harm.     The  caution  vsdth  reference  to 


28  INTRODUCTORY  LECTURE. 

it  on  this  ground  was  long  ago  recorded  in  the  Lec- 
ture above  referred  to.  See  what  Dr.  John  Hughes 
Bennett  says  of  it  in  the  recent  edition  of  his  work 
on  Medicine.  Nothing  but  the  most  careful  clmical 
experience  can  settle  this  and  such  points  of  treat- 
ment. 

These  are  all  practical  questions — questions  of  life 
and  death,  and  every  day  T\dll  be  full  of  just  such 
questions.  Take  the  problem  of  climate.  A  patient 
comes  to  you  with  asthma  and  wants  to  know  where  he 
can  breathe  ;  another  comes  to  you  with  phthisis  and 
wants  to  know  where  he  can  hve.  ^Yhat  boy's  play 
is  nine  tenths  of  all  that  is  taught  in  many  a  pretentious 
course  of  lectures,  compared  wdth  what  an  accurate 
and  extensive  knowledge  of  the  advantages  and  dis- 
advantages of  different  residences  in  these  and  other 
complaints  would  be  to  a  practising  physician !  I 
saw  the  other  day  a  gentleman  hving  in  Canada,  who 
had  spent  seven  successive  wmters  in  Egypt,  with  the 
enthe  reUef  of  certain  obscure  thoracic  symptoms 
which  troubled  him  while  at  home.  I  saw,  two 
months  ago,  another  gentleman  from  Minnesota,  an 
observer  and  a  man  of  sense,  who  considered  that 
State  as  the  great  sanatorium  for  all  pulmonary  com- 
plaints. If  half  our  groTVTi  population  are  or  will  be 
more  or  less  tuberculous,  the  question  of  colonizing 
Florida  assumes  a  new  aspect.  Even  within  the  bor- 
ders of  oiu-  own  State,  the  very  interesting  researches 
of  Dr.  Bowditch  show  that  there  is  a  great  variation 
in  the  amount  of  tuberculous  disease  in  different 
towms,  apparently  connected  with  local  conditions. 
The  hygienic  map  of  a  State  is  quite  as  valuable  as 


INTRODUCTORY   LECTURE.  29 

its  geological  map,  and  it  is  the  business  of  every 
practising  physician  to  know  it  thoroughly.  They 
understand  this  in  England,  and  send  a  patient  with 
a  dry  irritating  cough  to  Torquay  or  Penzance,  while 
they  send  another  with  relaxed  bronchial  membranes 
to  Clifton  or  Brighton.  Here  is  another  great  field 
for  practical  study. 

So  as  to  the  all-important  question  of  diet.  "  Of 
all  the  means  of  cure  at  our  command,"  says  Dr. 
Bennett,  "  a  regulation  of  the  quantity  and  quality 
of  the  diet  is  by  far  the  most  powerful."  Dr.  Mac- 
Cormac  would  perhaps  except  the  air  we  breathe,  for 
he  thinks  that  impure  air,  especially  in  sleepuig  rooms, 
is  the  great  cause  of  tubercle.  It  is  sufiiciently 
proved  that  the  American — the  New  Englander — the 
Bostonian — can  breed  strong  and  sound  children, 
generation  after  generation — nay,  I  have  shown  by 
the  record  of  a  particular  family  that  vital  losses  may 
be  retrieved,  and  a  feeble  race  grow  to  lusty  ^dgor  in 
this  very  climate  and  locality.  Is  not  the  question 
why  our  young  men  and  women  so  often  break  down, 
and  how  they  can  be  kept  from  breaking  down,  far 
more  important  for  physicians  to  settle  than  whether 
there  is  one  cranial  vertebra,  or  whether  there  are 
four,  or  none? 

— But  I  have  a  taste  for  the  homologies,  I  want 
to  go  deeply  into  the  subject  of  embryology,  I  want  to 
analyze  the  protoniliilates  precipitated  from  pigeon's 
milk  by  the  action  of  the  lunar  spectrum — shall  I 
not  follow  my  star — shaU  I  not  obey  my  instinct — 
shall  I  not  give  myself  to  the  lofty  pursuits  of  science 
for  its  own  sake?  — 


30  INTRODUCTORY   LECTURE. 

Certainly  you  may,  if  you  like.  But  take  down 
your  sign,  or  never  put  it  up.  That  is  the  way  Dr. 
Owen  and  Dr.  Huxley,  Dr.  Agassiz  and  Dr.  Jeffries 
AVjTnan,  Dr.  Gray  and  Dr.  Charles  T.  Jackson  set- 
tled the  difficulty.  We  all  adniii-e  the  achievements 
of  this  band  of  distinguished  doctors  who  do  not 
practise.  But  we  say  of  then*  work  and  of  all  pure 
science,  as  the  French  officer  said  of  the  charge  of 
the  six  hundred  at  Balaclava,  "  Cest  magnifiqiie^ 
mats  ce  nest  pas  la  guerre" — it  is  very  splendid, 
but  it  is  not  a  practising  doctor's  business.  His 
patient  has  a  right  to  the  cream  of  his  life  and  not 
merely  to  the  thin  milk  that  is  left  after  "  science  " 
has  skimmed  it  off.  The  best  a  physician  can  give 
is  never  too  good  for  the  patient. 

It  is  often  a  disadvantage  to  a  young  practitioner 
to  be  kno'wn  for  any  accomplishment  outside  of  his 
profession.  Haller  lost  his  election  as  Physician  to 
the  Hospital  in  his  native  city  of  Berne,  principally 
on  the  ground  that  he  was  a  poet.  In  his  later  years 
the  physician  may  ventui'e  more  boldly.  Astruc  was 
sixty-nine  years  old  when  he  published  his  "  Conjec- 
tures," the  first  attempt,  we  are  told,  to  decide  the 
authorship  of  the  Pentateuch  showing  anything  Hke 
a  discermng  criticism.  Sir  Benjamin  Brodie  was 
seventy  years  old  before  he  left  his  physiological  and 
sui'gical  studies  to  indidge  in  psychological  sj)ecida- 
tions.  The  period  of  pupilage  will  be  busy  enough  in 
acquiring  the  knowledge  needed,  and  the  season  of 
active  practice  w^iU  leave  little  leisure  for  any  but 
professional  studies. 

Dr.   Graves  of  Dublin,   one   of  the  fu'st  clinical 


INTRODUCTORY    LECTURE.  31 

teachers  of  our  time,  always  insisted  on  his  students' 
beginning  at  once  to  visit  the  hospital.  At  the  bed- 
side the  student  must  learn  to  treat  disease,  and  just 
as  certainly  as  we  spin  out  and  multiply  our  academic 
prelections  we  shall  work  in  more  and  more  stuffing, 
more  and  more  rubbish,  more  and  more  u-relevant, 
useless  detail  which  the  student  will  get  rid  of 
just  as  soon  as  he  leaves  us.  Then  the  next  thmg 
will  be  a  new  organization,  with  an  examining 
board  of  first  rate  practical  men,  who  will  ask  the 
candidate  questions  that  mean  business — who  will 
make  him  operate  if  he  is  to  be  a  Sui'geon,  and  try 
him  at  the  bed-side  if  he  is  to  be  a  physician — and 
not  puzzle  him  with  scientific  conundrums  which 
not  more  than  one  of  the  questioners  could  answer 
himself  or  ever  heard  of  since  he  graduated. 

Or  these  women  who  are  hammering  at  the  gates 
on  which  is  written-  "  No  admittance  for  the  mothers 
of  mankind,"  will  by  and  by  organize  an  institution, 
which  starting  from  that  skilful  kmd  of  nursing 
which  Florence  Nightingale  taught  so  well,  will  work 
backwards  thi-ough  anodynes,  palliatives,  curatives, 
preventives,  until  with  httle  show  of  science  it  imparts 
most  of  what  is  most  valuable  in  those  branches  of 
the  healing  art  it  professes  to  teach.  When  that 
time  comes,  the  fitness  of  women  for  certain  medical 
duties,  which  Hecquet  advocated  ui  1708,  which 
Douglas  maintained  in  1736,  which  Dr.  John  Ware, 
long  the  honored  Professor  of  Theory  and  Practice  in 
this  Institution,  upheld  within  our  own  recollection  in 
the  face  of  his  own  recorded  opmion  to  the  contrary, 
will  very  possibly  be  recognized.  . 


32  INTRODUCTORY   LECTURE. 

My  advice  to  every  teacher  less  experienced  than 
myself  would  be,  therefore ;  Do  not  fret  over  the 
details  you  have  to  oniit ;  you  probably  teach  alto- 
gether too  many  as  it  is.  Individuals  may  learn  a 
thing  with  once  hearing  it,  but  the  only  way  of  teach- 
ing a  whole  class  is  by  enormous  repetition,  re- 
jiresentation,  and  illustration  in  all  possible  forms. 
Now  and  then  you  will  have  a  young  man  on  your 
benches  Hke  the  late  Waldo  Bui-nett, — not  very  often, 
if  you  lecture  half  a  century.  You  cannot  pretend 
to  lecture  chiefly  for  men  hke  that, — a  INIississippi 
raft  might  as  well  take  an  ocean-steamer  in  tow.  To 
meet  his  wants  you  would  have  to  leave  the  rest  of 
yoiu-  class  behhid ,  and  that  you  must  not  do .  President 
Allen,  of  Jefierson  College,  says  that  his  instruction 
has  been  successfid  in  proportion  as  it  has  been 
elementary.  It  may  be  a  humiliating  statement,  but  it 
is  one  which  I  have  found  true  in  my  own  experience. 

To  the  student  I  would  say,  that  however  plain 
and  simple  may  be  our  teaching,  he  must  expect  to 
forget  much  which  he  follows  intelhgently  in  the 
lecture-room.  But  it  is  not  the  same,  as  if  he  had 
never  learned  it.  A  man  must  get  a  thing  before  he 
can  ybrget  it.  There  is  a  great  world  of  ideas  we 
cannot  voluntarily  recall — they  are  outside  the  limits 
of  the  will.  But  they  sway  our  conscious  thought  as 
the  unseen  planets  influence  the  movements  of  those 
within  the  sphere  of  \dsion.  No  man  knows  how 
much  he  knows, — ^how  many  ideas  he  has, — any  more 
than  he  knows  how  many  blood-globules  roll  in  his 
veins.  Sometimes  accident  brings  back  here  and  there 
one,  but  the  mind  is  full  of  irrcsocablc  remembrances 


INTEODUCTOEY   LECTUEE.  33 

and  iintliiiikable  thoughts,  which  take  a  part  in  all 
its  judgments  as  indestructible  forces.  Some  of  you 
must  feel  your  scientific  deficiencies  painfully  after 
yoiu"  best  eff"orts.  But  every  one  can  acquu-e  what  is 
most  essential.  A  man  of  very  moderate  ability  may 
be  a  good  physician,  if  he  devotes  himself  faithfully 
to  the  work.  More  than  this,  a  positively  dull  man, 
in  the  ordhiary  acceptation  of  the  term,  sometimes 
makes  a  safer  practitioner  than  one  who  has,  we  will 
say,  five  per  cent  more  brains  than  his  average  neigh- 
bor, but  who  thinks  it  is  fifty  per  cent.  Skulls  be- 
longing to  this  last  variety  of  the  human  race  are 
more  common,  I  may  remark,  than  specimens  Hke 
the  Neanderthal  cranium,  a  cast  of  which  you  will 
find  on  the  table  in  the  Museum. 

Whether  the  average  talent  be  high  or  low,  the 
Colleges  of  the  land  must  make  the  best  commodity 
they  can  out  of  such  material  as  the  country  and  the 
cities  furnish  them.  The  community  must  have  Doc- 
tors as  it  must  have  bread.  It  uses  up  its  Doctors  just 
as  it  wears  out  its  shoes,  and  requires  new  ones. 
All  the  bread  need  not  be  French  rolls,  all  the  shoes 
need  not  be  patent  leather  ones  ;  but  the  bread  must 
be  somethmg  that  can  be  eaten,  and  the  shoes  must 
be  somethmg  that  can  be  worn.  Life  must  somehow 
find  food  for  the  two  forces  that  rub  everythmg  to 
pieces,  or  bum  it  to  ashes,— friction  and  oxygen. 
Doctors  are  oxydablc  products,  and  the  schools  must 
keep  fiu'nishing  new  ones  as  the  old  ones  tiu-n  into 
oxyds ;  some  of  first  rate  quality  that  burn  mth  a 
great  light, — some  of  a  lower  grade  of  brilliancy, 
5 


34:  INTEODUCTOEY  LECTUEE. 

some  honestly,  unmistakably,  by  the  grace  of  God,  of 
moderate  gifts,  or  in  simpler  phrase,  dull. 

The  public  "will  give  every  honest  and  reasona- 
bly competent  w^orker  in  the  healing  art  a  hearty 
welcome.  It  is  on  the  whole  very  loyal  to  the  INIedi- 
cal  Profession.  Three  successive  years  have  borne 
witness  to  the  feeling  with  which  this  Institution, 
representing  it  in  its  educational  aspect,  is  regarded 
by  those  who  are  themselves  most  honored  and 
esteemed.  The  great  Master  of  Natm-al  Science 
bade  the  last  year's  class  farewell  in  om'  behalf,  in 
those  accents  which  delight  every  audience.  The 
Head  of  our  ancient  University  honored  us  in  the 
same  way  in  the  preceding  season.  And  how  can  we 
forget  that  other  occasion  when  the  Chief  ^lagistrate 
of  the  Commonwealth,  that  noble  citizen  whom  we 
have  just  lost,  large-souled,  sweet-natured,  always 
ready  for  every  kind  office,  came  among  us  at  our 
bidding,  and  talked  to  us  of  our  duties  in  words  as 
full  of  wisdom  as  his  heart  was  of  goodness  ? 

You  have  not  much  to  fear,  I  think,  from  the 
fancy  practitioners.  The  vulgar  quackeries  drop  oif, 
atrophied,  one  after  another.  Homcoopathy  has  long 
been  encysted,  and  is  carried  on  the  body  medical  as 
quietly  as  an  old  wen.  Every  year  gives  you  a  more 
reasonmg  and  reasonable  people  to  deal  with.  See 
how  it  is  in  Literature.  The  dynasty  of  British 
dogmatists,  after  lasting  a  hundred  years  and  more, 
is  on  its  last  legs.  Thomas  Carlyle,  thu'd  in  the  line 
of  descent,  finds  an  audience  very  different  from  those 
which  listened  to  the  silver  speech  of  Samuel  Taylor 
Coleridge  and  the  sonorous  phrases  of  Samuel  John- 


mXEODUCTORY   LECTURE.  35 

son.  We  read  him,  we  smile  at  his  clotted  English, 
his  "swannery"  and  other  j)icturesque  expressions, 
but  we  lay  down  his  tirade  as  we  do  one  of  Dr.  Cum- 
ming's  interpretations  of  pro^^hecy,  which  tells  us 
that  the  world  is  coming  to  an  end  next  week  or  next 
month,  if  the  weather  permits, — not  otherwise, — feel- 
ing very  sure  that  the  weather  will  be  unfavorable. 

It  is  the  same  common-sense  public  you  will  appeal 
to.  The  less  pretension  you  make,  the  better  they 
"will  like  you  in  the  long  run.  I  hope  we  shall  make 
everything  -as  plain  and  as  simple  to  you  as  we  can. 
I  would  never  use  a  long  word,  even,  where  a  short 
one  would  answer  the  purpose.  I  know  there  are 
professors  in  this  country  who  "  ligate "  arteries. 
Other  surgeons  only  tie  them,  and  it  stops  the  bleeding 
just  as  well.  It  is  the  familiarity  and  simplicity  of 
bedside  mStruction  which  makes  it  so  pleasant  as 
well  as  so  profitable.  A^ood  clinical  teacher  is 
himself  a  INIedical  School.  We  need  not  wonder  that 
our  young  men  are  beginning  to  announce  themselves 
not  only  as  graduates  of  this  or  that  College,  but  also 
as  pupils  of  some  one  distmguished  master. 

I  wish  to  close  this  Lecture,  if  you  "svill  allow  me 
a  few  moments  longer,  with  a  brief  sketch  of  an 
instructor  and  practitioner  whose  character  was  as 
nearly  a  model  one  in  both  capacities  as  I  can  find 
any  where  recorded. 

Dr.  James  Jacksox,  Professor  of  the  Theory  and 
Practice  of  Medicine  in  this  University  from  1812  to 
1836,  and  whose  name  has  been  since  retained  on 
our  rolls  as  Professor  Emeritus,  died  on  the  27th  of 


36  INTRODUCTORY   LECTURE. 

August  last,  in  the  ninetieth  year  of  his  age.  He 
studied  his  profession,  as  I  have  abeady  mentioned, 
with  Dr.  Holyoke  of  Salem,  one  of  the  few  physicians 
who  have  borne  witness  to  their  knowledge  of  the 
laws  of  life  by  li\dng  to  complete  then-  hmidredth 
year.  I  think  the  student  took  his  Old  Master,  as 
he  always  loved  to  call  him,  as  his  model ;  each  was 
worthy  of  the  other,  and  both  were  bright  examples 
to  all  who  come  after  them. 

I  remember  that  in  the  sermon  preached  by  Dr. 
Brazer  after  Dr.  Holyoke's  death,  one  of  the  points 
most  insisted  upon  as  characteristic  of  that  vdse  and 
good  old  man  was  the  perfect  balance  of  all  his  facul- 
ties. The  same  harmonious  adjustment  of  powers, 
the  same  symmetrical  arrangement  of  life,  the  same 
complete  fulfilment  of  every  day's  duties,  -without 
haste  and  without  needless  delay,  which  characterized 
the  master,  equally  disflnguished  the  scholar.  A 
glance  at  the  life  of  our  own  Old  Master,  if  I  can 
do  any  justice  at  all  to  his  excellencies,  will  give  you 
something  to  carry  away  from  this  hour's  meeting 
not  unworthy  to  be  remembered. 

From  December,  1797,  to  October,  1799,  he  re- 
mained A\dth  Dr.  Holyoke  as  a  student,  a  period 
which  he  has  spoken  of  as  a  most  interesting  and 
most  gratifying  part  of  his  life.  After  this  he  passed 
eight  months  in  London,  and  on  his  return,  in 
October,  1800,  he  began  business  in  Boston. 

He  had  followed  IVIr.  Cline,  as  I  have  mentioned, 
and  was  competent  to  practise  Surgery.  But  he  found 
Dr.  John  Collins  Warren  had  already  occupied  the 
ground  which  at  that  day  hardly  called  for  more  than 


INTRODUCTORY   LECTURE.  37 

one  leading  practitioner,  and  wisely  chose  the  Medi- 
cal branch  of  the  profession.  He  had  only  himself 
to  rely  upon,  but  he  had  confidence  ui  his  prospects, 
conscious,  doubtless,  of  his  otmi  powers,  knowing 
his  OT\Ti  industry  and  determination,  and  being  of 
an  eminently  cheei"fid.  and  hopeful  disposition.  No 
better  proof  of  his  sphit  can  be  given  than  that,  just 
a  year  from  the  time  when  he  began  to  j)ractise  as  a 
physician,  he  took  that  eventful  step  which  in  such  a 
man  implies  that  he  sees  his  way  clear  to  a  position ; 
he  married  a  lady  blessed  mth  many  gifts,  but  not 
bringmg  him  a  fortune  to  paralyze  his  industry. 

He  had  not  miscalculated  his  chances  in  hfe.  He 
very  soon  rose  into  a  good  practice,  and  began  the 
founding  of  that  reputation  which  grew  with  his 
years,  mitil  he  stood  by  general  consent  at  the  head 
of  his  chosen  branch  of  the  profession,  to  say  the 
least,  in  this  city  and  in  all  this  region  of  country. 
His  skill  and  wisdom  were  the  last  tribunal  to  which 
the  sick  and  sufFermg  could  appeal.  The  community 
trusted  and  loved  him,  the  profession  recognized  him 
as  the  noblest  type  of  the  physician.  The  young  men 
whom  he  had  taught  wandered  through  foreign  hos- 
pitals, where  they  learned  many  things  that  were 
valuable,  and  many  that  were  curious ;  but  as  they 
grew  older  and  began  to  think  more  of  theh  ability 
to  help  the  sick  than  thek  power  of  talkmg  about 
phenomena,  they  began  to  look  back  to  the  teaching 
of  Dr.  Jackson,  as  he,  after  his  London  experience, 
looked  back  to  that  of  Dr.  Holyoke.  And  so  it  came 
to  be  at  last  that  the  bare  mention  of  his  name  in  any 
of  our  medical  assemblies  would  call  forth  such  a 


38  INTRODUCTORY   LECTURE. 

tribute  of  affectionate  regard  as  is  only  yielded  to 
age  when  it  brings  with  it  the  record  of  a  life  spent 
in  well  domg. 

No  accident  ever  carries  a  man  to  eminence  such 
as  his  m  the  medical  profession.  He  who  looks  for 
it  must  want  it  "earnestly  and  work  for  it  vigorously  ; 
Xature  must  have  qualified  him  in  many  ways,  and 
education  must  have  equipped  him  with  various 
knowledge,  or  his  reputation  will  evaporate  before  it 
reaches  the  noon-day  blaze  of  fame.  How"  did  Dr. 
Jackson  gain  the  position  which  all  conceded  to 
him?  In  the  answer  to  this  question  some  among 
you  may  find  a  key  that  shall  unlock  the  gate  opening 
on  that  fah  field  of  the  future  of  which  all  di-eam  but 
which  not  all  ^vill  ever  reach. 

Fu'st  of  all,  he  truly  loved  his  profession.  He  had 
no  mtellectual  ambitions  outside  of  it,  literary,  scien- 
tific or  political.  To  him  it  was  occupation  enough 
to  apply  at  the  bed-side  the  best  of  all  that  he  knew 
for  the  good  of  his  patient ;  to  protect  the  community 
against  the  inroads  of  pestilence ;  to  teach  the  young 
all  that  he  himself  had  been  taught,  with  all  that  liis 
o^\Ti  experience  had  added ;  to  leave  on  record  some 
of  the  most  important  residts  of  his  long  observation. 

With  his  patients  he  was  so  perfect  at  all  points 
that  it  is  hard  to  overpraise  him.  I  have  seen  many 
noted  British  and  French  and  American  practitioners, 
but  I  never  saw  the  man  so  altogether  admii-able  at 
the  bed-side  of  the  sick  as  Dr.  James  Jackson.  His 
smile  was  itself  a  remedy  better  than  the  potable  gold 
and  the  dissolved  pearls  that  comforted  the  prtecordia 
of  mediaeval  monarchs.     Did  a  patient,  alarmed  with- 


INTEODUCTORY    LECTURE.  39 

out  cause,  need  encouragement,  it  carried  the  sun- 
shine of  hope  into  his  heart  and  put  all  his  whims  to 
flight,  as  David's  harp  cleared  the  haunted  chamber 
of  the  sullen  kmg.  Had  the  hour  come,  not  for 
encouragement,  but  for  s}Tnpathy,  his  face,  his  voiccj 
his  manner  aU  showed  it,  because  his  heart  felt  it. 
So  gentle  was  he,  so  thoughtful,  so  calm,  so  absorbed 
in  the  case  before  him,  not  to  tiu-n  round  and  look 
for  a  tribute  to  his  sagacity,  not  to  bolster  himself  in 
a  favorite  theory,  but  to  find  out  all  he  could,  and  to 
weigh  gravely  and  cautiously  all  that  he  found,  that 
to  follow  him  m  his  mornmg  visit  was  not  only  to 
take  a  lesson  in  the  healing  art,  it  was  learning  how 
to  learn,  how  to  move,  how  to  look,  how  to  feel,  if 
that  can  be  learned.  To  visit  with  Dr.  Jackson  was 
a  medical  education. 

He  was  very  fii'm,  with  all  his  kmdness.  He 
would  have  the  truth  about  his  patients.  The  nurses 
found  it  out,  and  the  shrewder  ones  never  ventured 
to  tell  him  any  thing  but  a  straight  story.  A  clinical 
dialogue  between  Dr.  Jackson  and  Miss  Rebecca 
Taylor,  sometime  nurse  in  the  Massachusetts  General 
Hospital,  a  mistress  m  her  calling,  was  as  good  ques- 
tioning and  answering  as  one  would  be  like  to  hear 
outside  of  the  coiu"t-room. 

Of  his  practice  you  can  form  an  opinion  from  his 
book  called  "  Letters  to  a  Young  Physician."  Like 
all  sensible  men  from  the  days  of  Hippocrates  to  the 
present,  he  knew  that  diet  and  regimen  were  more 
important  than  any  drug  or  than  all  drugs  put  to- 
gether. Witness  his  treatment  of  phthisis  and  of 
epilepsy.     He  retained,  however,  more  confidence  in 


40  INTEODUCTORY   LECTURE. 

some  remedial  agents  than  most  of  the  younger  gene- 
ration would  concede  to  them.  Yet  his  materia 
medica  was  a  simple  one. 

"  When  I  fii'st  went  to  live  with  Dr.  Holyoke,"  he 
says,  "  in  1797,  showing  me  his  shop,  he  said,  '  There 
seems  to  you  to  be  a  great  variety  of  medicmes  here, 
and  that  it  w  ill  take  you  long  to  get  acquamted  with 
them,  but  most  of  them  are  unimportant.  There  are 
four  which  are  equal  to  all  the  rest,  namely,  Mercury, 
Antimony,  Bark  and  Opium.' "  And  Dr.  Jackson 
adds,  "  I  can  only  say  of  his  practice,  the  longer  I 
have  Hved,  I  have  thought  better  and  better  of  it." 
"When  he  thought  it  necessary  to  give  medicine,  he 
gave  it  in  earnest.  He  hated  half-practice — gi^TLUg  a 
little  of  this  or  that,  so  as  to  be  able  to  say  that  one 
had  done  something,  in  case  a  consultation  was  held, 
or  a  still  more  ommous  event  occiu-red.  He  would 
give  opium,  for  instance,  as  boldly  as  the  late  Dr. 
Fisher  of  Beverly,  but  he  followed  the  aphorism  of 
the  Father  of  Medicine,  and  ke^Dt  extreme  remedies 
for  extreme  cases. 

When  it  came  to  the  "  non-naturals,"  as  he  would 
sometimes  call  them,  after  the  old  physicians, — namely, 
air,  meat  and  diink,  sleep  and  watcliing,  motion  and 
rest,  the  retentions  and  excretions,  and  the  affections 
of  the  mind, — he  was,  as  I  have  said,  of  the  school  of 
sensible  practitioners,  in  distinction  from  that  vast 
commimity  of  quacks,  with  or  without  the  diploma, 
who  think  the  chief  end  of  man  is  to  support  apothe- 
caries, and  are  never  easy  until  they  can  get  every 
patient  upon  a  regular  course  of  something  nasty  or 
noxious.     Nobody  was  so  precise  in  his  directions 


INTRODUCTORY   LECTURE,  41 

about  diet,  air  and  exercise,  as  Dr.  Jackson.  He 
had  the  same  dishke  to  the  a  peu  pres,  the  about  so 
much,  about  so  often,  about  so  long,  which  I  after- 
wards found  among  the  punctihous  adherents  of  the 
numerical  system  at  La  Pitie. 

He  used  to  insist  on  one  small  point  with  a  cer- 
tain philological  precision,  namely,  the  true  meaning 
of  the  word  "  cure."  He  would  have  it  that  to  cure 
a  patient  was  simply  to  care  for  him.  I  refer  to  it 
as  sho^ving  what  his  idea  was  of  the  relation  of  the 
physician  to  the  patient.  It  was  indeed  to  care  for 
him,  as  if  his  life  was  bound  up  in  him,  to  watch  his 
incommgs  and  outgoings,  to  stand  guard  at  every 
avenue  that  disease  might  enter,  to  leave  nothing  to 
chance ;  not  merely  to  throw  a  few  j)ills  and  powders 
into  one  pan  of  the  scales  of  Fate,  while  Death  the 
skeleton  was  seated  in  the  other,  but  to  lean  with  his 
whole  weight  on  the  side  of  life,  and  shift  the  balance 
in  its  favor  if  it  lay  in  human  power  to  do  it.  Such 
devotion  as  this  is  only  to  be  looked  for  in  the  man  who 
gives  himself  wholly  up  to  the  business  of  healmg, 
who  considers  Medicine  itself  a  Science,  or  if  not  a 
science,  is  wiUing  to  foUow  it  as  an  art, — the  noblest 
of  arts,  which  the  gods  and  demigods  of  ancient  reli- 
gions did  not  disdain  to  practise  and  to  teach. 

The  same  zeal  made  him  always  ready  to  listen  to 
any  new  suggestion  which  promised  to  be  useful,  at 
a  period  of  life  when  many  men  find  it  hard  to  learn 
new  methods  and  accept  new  doctrines.  Few  of  his 
generation  became  so  accomplished  as  he  in  the  arts 
of  dkect  exploration;  coming  straight  from  the 
Parisian  experts,  I  have  examined  many  patients 
6 


42  INTRODUCTOEY   LECTURE. 

with  him,  and  have  had  frequent  opportunities  of 
observing  his  skill  in  percussion  and  auscultation. 

One  element  in  his  success,  a  trivial  one  compared 
with  others,  but  not  to  be  despised,  was  his  punctu- 
ality. He  always  carried  two  watches, — I  doubt  if  he 
told  why,  any  more  than  Dr.  Johnson  told  what  he 
did  with  the  orange-peel, — but  probably  with  refer- 
ence to  this  vu'tue.  He  was  as  much  to  be  depended 
upon  at  the  appointed  time  as  the  solstice  or  the 
equinox.  There  was  another  point  I  have  heard 
him  speak  of  as  an  important  rule  with  him;  to 
come  at  the  hour  when  he  was  expected ;  if  he  had 
made  his  \isit  for  several  days  successively  at  ten 
o'clock,  for  instance,  not  to  put  it  off,  if  he  could 
possibly  help  it,  until  eleven,  and  so  keep  a  nervous 
patient  and  an  anxious  family  waiting  for  him  through 
a  long,  weary  hour. 

If  I  should  attempt  to  characterize  his  teaching,  I 
shoidd  say  that  while  it  conveyed  the  best  results  of 
his  sagacious  and  extended  observation,  it  was  singu- 
larly modest,  cautious,  simple,  sincere.  Nothing 
was  for  show,  for  self-love ;  there  was  no  rhetoric, 
no  declamation,  no  triumphant  "  I  told  you  so,"  but 
the  plain  statement  of  a  clear-headed  honest  man, 
who  knows  that  he  is  handling  one  of  the  gravest 
subjects  that  interest  himianity.  His  positive  in- 
sti'uctions  were  full  of  value,  but  the  spii'it  in  which 
he  taught  inspked  that  loyal  love  of  truth  which  Hes 
at  the  bottom  of  all  real  excellence. 

I  will  not  say  that,  duiing  his  long  career,  Dr. 
Jackson  never  made  an  enemy.  I  have  heard  him 
tell  how,  in  his  very  early  days,  old  Dr.  Danforth  got 


INTEODUCTORY   LECTURE.  43 

into  a  towering  passion  mth  him  about  some  profes- 
sional consultation,  and  exploded  a  monosyllable  or 
two  of  the  more  energetic  kind  on  the  occasion.  I 
remember  that  that  somewhat  peculiar  personage,  Dr. 
Waterhouse,  took  it  hardly  when  Dr.  Jackson ,  suc- 
ceeded to  his  place  as  Professor  of  Theory  and  Prac- 
tice. A  young  man  of  Dr.  Jackson's  talent  and 
energy  could  hardly  take  the  position  that  belonged 
to  him  without  crowding  somebody  in  a  profession 
where  three  in  a  bed  is  the  common  rule  of  the 
household.  But  he  was  a  peaceful  man  and  a  peace- 
maker all  his  days.  No  man  ever  did  more,  if  so 
much,  to  produce  and  maintain  the  sphit  of  harmo- 
ny for  which  we  consider  our  medical  community  as 
somewhat  exceptionally  distinguished. 

If  this  harmony  should  ever  be  threatened,  I  could 
wish  that  every  impatient  and  irritable  member  of 
the  profession  would  read  that  beautiful,  that  noble 
Preface  to  the  "  Letters,"  addressed  to  John  Collins 
Warren.  I  know  nothing  finer  in  the  medical  litera- 
ture of  all  time  than  this  Prefatory  Introduction.  It 
is  a  golden  prelude,  fit  to  go  with  the  three  great 
Prefaces  which  challenge  the  admiration  of  scholars, 
— Calvin's  to  his  Institutes,  De  Thou's  to  his  History, 
and  Casaubon's  to  his  Polybius, — not  because  of  any 
learning  or  rhetoric,  though  it  is  charmingly  written, 
but  for  a  spirit  flowing  through  it  to  which  learning 
and  rhetoric  are  but  as  the  breath  that  is  wasted  on 
the  air  to  the  blood  that  warms  the  heart. 

Of  a  similar  character  is  this  short  extract  which  I 
am  permitted  to  make  from  a  private  letter  of  his  to 


44  INTRODUCTORY   LECTURE. 

a  dear  young  friend.  He  was  eighty-three  years  old 
at  the  time  of  writing  it. 

"  I  have  not  loved  every  body  whom  I  have  known, 
but  I  have  striven  to  see  the  good  points  m  the  char- 
acters of  all  men  and  women.  At  first  I  must  have 
done  this  from  somethmg  in  my  own  nature,  for  I 
was  not  aware  of  it,  and  yet  was  doing  it  without 
any  plan,  when  one  day,  sixty  years  ago,  a  friend 
whom  I  loved  and  respected  said  this  to  me,  '  Ah, 
James,  I  see  that  you  are  destined  to  succeed  in  the 
worlds  and  to  make  friends,  because  you  are  so  ready 
to  see  the  good  points  in  the  characters  of  those  you 
meet.'  " 

I  close  this  imperfect  notice  of  some  features  in 
the  character  of  this  most  honored  and  beloved  of 
physicians  by  appl}dng  to  him  the  words  which  were 
written  of  Wilham  Heberden,  whose  career  was  not 
unhke  his  o^\ti,  and  who  hved  to  the  same  i)atri- 
archal  age. 

"  From  his  early  youth  he  had  always  entertained 
a  deep  sense  of  religion,  a  consummate  love  of  virtue, 
an  ardent  thu*st  after  knowledge,  and  an  earnest 
desu'e  to  promote  the  welfare  and  happmess  of  all 
mankind.  By  these  qualities,  accompanied  with 
great  sweetness  of  manners,  he  acquhed  the  love  and 
esteem  of  all  good  men,  m  a  degree  which  perhaps 
very  few  have  experienced ;  and  after  passing  an 
active  life  ^^dth  the  imiform  testimony  of  a  good  con- 
science, he  became  an  eminent  example  of  its  influ- 
ence, in  the  cheerfulness  and  serenity  of  his  latest 
age." 


INTEODUCTORY   LECTURE.  45 

Such  was  the  man  whom  I  offer  to  you  as  a  model, 
yoimg  gentlemen,  at  the  outset  of  your  medical 
career.  I  hope  that  many  of  you  will  recognize 
some  traits  of  your  own  special  teachers  scattered 
through  various  parts  of  the  land  in  the  picture  I 
have  drawn.  Let  me  assure  you  that  whatever  you 
may  learn  in  this  or  any  other  course  of  pubHc  lec- 
tures,— and  I  trust  you  will  leam  a  great  deal, — the 
daily  guidance,  counsel,  example,  of  your  medical 
father,  for  such  the  Oath  of  Hippocrates  tells  you 
to  consider  your  preceptor,  will,  if  he  is  in  any 
degree  like  him  of  whom  I  have  spoken,  be  the 
foundation  on  which  all  that  we  teach  is  reared,  and 
perhaps  outlive  most  of  our  teachings,  as  m  Dr. 
Jackson's  memory  the  last  lessons  that  remained 
with  him  were  those  of  his  Old  Master. 


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